April 24, 2010, the Mayor and City Council made Seattle the first city in the United States to take on a ten-year commitment to become a more compassionate city

Compassionate Action Network

Physician/Patient CompassionPhysician/Patient Compassion

Steve Overman MD MPHDocOverman@gmail.com

The Seattle Arthritis Clinic

CompassionCompassion

The human quality of understanding the suffering of others

and

wanting to do something about it.

The human quality of understanding the suffering of others

and

wanting to do something about it.

Rachel Naomi Remen, MDRachel Naomi Remen, MD

“We suffer not because we are in pain, but because we are in pain

alone.”

Kitchen Table Wisdom

“We suffer not because we are in pain, but because we are in pain

alone.”

Kitchen Table Wisdom

Do you want the most compassionate care or

the best care outcomes?

Do you want the most compassionate care or

the best care outcomes?

“The Bell Curve”

Atul Gawanda, MD MPHThe New Yorker

12.6.2004

“The Bell Curve”

Atul Gawanda, MD MPHThe New Yorker

12.6.2004

Mast Cell Activation Disorder

Mast Cell Activation Disorder

Anaphylaxis and fear of death Fear of the unknown – what triggers? Disability with chronic daily symptoms Overwhelmed trying to navigate complex

medical symptom to find answers Social isolation from lost confidence and

friends saying “You don’t look sick”

Anaphylaxis and fear of death Fear of the unknown – what triggers? Disability with chronic daily symptoms Overwhelmed trying to navigate complex

medical symptom to find answers Social isolation from lost confidence and

friends saying “You don’t look sick”

Crossing the Quality Chasm: A New Health System

for the 21st CenturyThe Institute of Medicine, 2001

Crossing the Quality Chasm: A New Health System

for the 21st CenturyThe Institute of Medicine, 2001

Donald Berwick, MD

10 Rules for Healthcare System Redesign

Rule # 7 : “The health care system should make information available to patients and their families that allow them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments.”

Donald Berwick, MD

10 Rules for Healthcare System Redesign

Rule # 7 : “The health care system should make information available to patients and their families that allow them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments.”

The Bell Curveof Normal DistributionThe Bell Curveof Normal Distribution

Advances in Scientific EvidenceAdvances in Scientific Evidence

“Chasm” Rule #5 - Evidence-based decision making: Patients should receive care based on the best available scientific knowledge

Annie Annie

If you were her parent,

what would you have done?

If you were her parent,

what would you have done?

Compassionate Care?Compassionate Care?

“Dr. Warwick’s combination

of focus, aggressiveness, and inventiveness

is what makes him extraordinary.

He thinks hard about his patients, he pushes them, and he does not hesitate to improvise.”

“Dr. Warwick’s combination

of focus, aggressiveness, and inventiveness

is what makes him extraordinary.

He thinks hard about his patients, he pushes them, and he does not hesitate to improvise.”

What is the evidence?

What is the evidence?

Does compassionate

lead to better outcomes?

Can a person learn to

become more compassionate?

Does compassionate

lead to better outcomes?

Can a person learn to

become more compassionate?

What correlates with Empathy?What correlates with Empathy?

dutifulness prosocial behavior moral reasoning good attitudes toward elderly patients a reduction in malpractice litigation patient satisfaction physician satisfaction better therapeutic relationships competence in history taking and performance of physical

examinations

AND

better clinical outcomes

dutifulness prosocial behavior moral reasoning good attitudes toward elderly patients a reduction in malpractice litigation patient satisfaction physician satisfaction better therapeutic relationships competence in history taking and performance of physical

examinations

AND

better clinical outcomes

Hojat: “Empirical Benefits of Empathy in Medicine”, Am Jr Psy, 2002

How Compassion Improves OutcomesHow Compassion Improves Outcomes

“Superior treatment effects enabled by a successful relationship

between the patient and the treating physician have been reported

in many studies . The effects can be attributed to treatment processes like :adherence and compliance, information exchange,adjustment of expectations, self-regulation and coping, which are fostering treatment results like functional status, return to work rates, pain relief, reduction of depression and anxiety and adjusting clinical parameters like blood pressure and blood sugar levels.”

“Superior treatment effects enabled by a successful relationship

between the patient and the treating physician have been reported

in many studies . The effects can be attributed to treatment processes like :adherence and compliance, information exchange,adjustment of expectations, self-regulation and coping, which are fostering treatment results like functional status, return to work rates, pain relief, reduction of depression and anxiety and adjusting clinical parameters like blood pressure and blood sugar levels.”

Dibbelt: “Patient-doctor interaction in rehabilitation”. Patient Educ Couns. 2009 Sep;76(3):328-35

How Compassion Improves OutcomesHow Compassion Improves Outcomes

Earlier and more accurate diagnoses

More efficient treatment planning and patient adherence

Communication increased physical functioning, emotional health, and decreased physical symptoms of pain

Patients feel more secure and emotional states impact the rate of healing.

Earlier and more accurate diagnoses

More efficient treatment planning and patient adherence

Communication increased physical functioning, emotional health, and decreased physical symptoms of pain

Patients feel more secure and emotional states impact the rate of healing.

Post: “Compassionate care enhancement: benefits and outcomes” The International Journal of Person Centered Medicine Volume 1 Issue 4 pp 808-813, 2011www.psychologytoday.com

How are we doing?How are we doing? How are compassionate care goals

reflected in the redesign of our

healthcare system?

How compassionate is our care in the perception of patients and physicians?

And for those who want to be the best, or for patients who want the best, how do we create and assure compassionate care?

How are compassionate care goals

reflected in the redesign of our

healthcare system?

How compassionate is our care in the perception of patients and physicians?

And for those who want to be the best, or for patients who want the best, how do we create and assure compassionate care?

Crossing the Quality Chasm: A New Health System for the 21st Century

Ten rules for healthcare system redesign

Crossing the Quality Chasm: A New Health System for the 21st Century

Ten rules for healthcare system redesign

Rule #1. “Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits.”

Rule #2. “Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.”

Rule 3. “The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.”

Rule 4. “Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.”

Rule #1. “Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits.”

Rule #2. “Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.”

Rule 3. “The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.”

Rule 4. “Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.”

An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients

Say Such Care Is Missing

An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients

Say Such Care Is Missing

Show respect for you, your family, and those important to you 68Treat you as a person, not just a disease 66Convey information to you in a way that is understandable 63Communicate test results in a timely and sensitive manner 63Gain your trust 61Listen attentively to you 59Always involve you in decisions about your treatment 59Express sensitivity, caring, and compassion for your situation 58Spend enough time with you 53Consider the effect of your illness on you, your family, and the people most

important to you 51Comfortably discuss sensitive, emotional, or psychological issues 50Strive to understand your emotional need 49Give you hope, even when the news is bad 48Show understanding of your cultural and religious beliefs 47

Show respect for you, your family, and those important to you 68Treat you as a person, not just a disease 66Convey information to you in a way that is understandable 63Communicate test results in a timely and sensitive manner 63Gain your trust 61Listen attentively to you 59Always involve you in decisions about your treatment 59Express sensitivity, caring, and compassion for your situation 58Spend enough time with you 53Consider the effect of your illness on you, your family, and the people most

important to you 51Comfortably discuss sensitive, emotional, or psychological issues 50Strive to understand your emotional need 49Give you hope, even when the news is bad 48Show understanding of your cultural and religious beliefs 47

Lown: “An Agenda For Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care is Missing “Health Affairs,30, no.9 (2011):1772-1778

Are the youth our hope?Are the youth our hope?

A meta-analysis of Interpersonal Reactivity Index of 13,000 American college students between 1979 and 2009

75% students were less empathetic than students 30 years ago

An increase in social isolation, has coincided with the drop in empathy

Konrath SH online in Personality and Social Psychology Review: Aug 2010

A meta-analysis of Interpersonal Reactivity Index of 13,000 American college students between 1979 and 2009

75% students were less empathetic than students 30 years ago

An increase in social isolation, has coincided with the drop in empathy

Konrath SH online in Personality and Social Psychology Review: Aug 2010

Are we Are we isolated and lost isolated and lost

and and therefore therefore

less empathic?less empathic?

Should we despair?

David Elaimy Golf Coach David Elaimy Golf Coach

Performance = Skills - Interferences Performance = Skills - Interferences

Course on CompassionSwedish Medical Center

Gordon Irving, MD Director of the Pain Center

Providing COMPASSIONate Care “The human quality of understanding the suffering of others

and wanting to do something about it.”

Providing COMPASSIONate Care “The human quality of understanding the suffering of others

and wanting to do something about it.”

Skillsunderstanding other’s suffering

by

giving attention

and

wanting to do something

through

understanding the 4 phases of chronic illness

minus

Interferences

Skillsunderstanding other’s suffering

by

giving attention

and

wanting to do something

through

understanding the 4 phases of chronic illness

minus

Interferences

“Anger Management Goes to the Doctor”

Business Week

Doctors Without

Boundaries

Interferences

Interferences

Poor emotional health Environmental “noise” “Me” focus Looking ahead Lost hope for the patient

Poor emotional health Environmental “noise” “Me” focus Looking ahead Lost hope for the patient

Watch and learn from these additional pictures slideshows.Pet Health•What You Need to Know About Fleas & Ticks Nerve Pain•Symptoms, Causes and Treatment Options

Food Frauds•What Can Wreck Your Diet

Brain FunctionBrain Function

Functional MRI allows study of brain activity. Patients with Fibromyalgia have “real” pain Empathy triggers mirror neurons and the stress ctr Stress centers activate the immune, endocrine and

autonomic nervous systems. Compassion (empathy followed by the desire to

help) turns off those stress centers

Lutz A et al. (2008). Regulation of the Neural Circuitry of Emotion by Compassion Meditation: Effects of Meditative Expertise PLoS ONE, 3 (3) DOI: 0.1371/journal.pone.0001897

Functional MRI allows study of brain activity. Patients with Fibromyalgia have “real” pain Empathy triggers mirror neurons and the stress ctr Stress centers activate the immune, endocrine and

autonomic nervous systems. Compassion (empathy followed by the desire to

help) turns off those stress centers

Lutz A et al. (2008). Regulation of the Neural Circuitry of Emotion by Compassion Meditation: Effects of Meditative Expertise PLoS ONE, 3 (3) DOI: 0.1371/journal.pone.0001897

Training the BrainCan you teach old dogs

new tricks?

Training the BrainCan you teach old dogs

new tricks?

Angry doctors training – tests of emotional self awareness; breathing exercises, visualization, self-talk*

Compassion Cultivation Training protocol (CCT) resulted in significant improvements in all three domains of compassion—compassion for others, receiving compassion from others, and self-compassion.**

*Chase Scheinbaum: Bloomberg.com August 12,2012

**Jazaieri: “Enhancing Compassion: A Randomized Controlled Trial of a Compassion Cultivation Training Program; J Happiness Stud; 2012 DOI 10.1007/s10902-012-9373-z

Angry doctors training – tests of emotional self awareness; breathing exercises, visualization, self-talk*

Compassion Cultivation Training protocol (CCT) resulted in significant improvements in all three domains of compassion—compassion for others, receiving compassion from others, and self-compassion.**

*Chase Scheinbaum: Bloomberg.com August 12,2012

**Jazaieri: “Enhancing Compassion: A Randomized Controlled Trial of a Compassion Cultivation Training Program; J Happiness Stud; 2012 DOI 10.1007/s10902-012-9373-z

Wanting to do something?Wanting to do something?

Does understanding and knowing ‘ what to do’ create motivation?

Joy said, “I can be WELL and still have an illness.”

Does understanding and knowing ‘ what to do’ create motivation?

Joy said, “I can be WELL and still have an illness.”

The 4 PHASES of Chronic, Invisible Illness

The 4 PHASES of Chronic, Invisible Illness

1) GETTING SICK Crisis of the onset of illness Fears of the unknown.

2) BEING SICK Controlling pain and inflammation Feelings of frustration and anger

1) GETTING SICK Crisis of the onset of illness Fears of the unknown.

2) BEING SICK Controlling pain and inflammation Feelings of frustration and anger

The 4 PHASES of Chronic, Invisible Illness

The 4 PHASES of Chronic, Invisible Illness

3) GRIEF & ACCEPTANCE “The illness is not going away.”Working through grief and finding

acceptance

4) LEARNING TO LIVE WELL Finding meaning in her illnessUnderstanding allow rejoining her communityGiving back to her family and society.

3) GRIEF & ACCEPTANCE “The illness is not going away.”Working through grief and finding

acceptance

4) LEARNING TO LIVE WELL Finding meaning in her illnessUnderstanding allow rejoining her communityGiving back to her family and society.

“Seeing Things Their Way”“Seeing Things Their Way”

Phase I - crisis needs HOPE

Phase II - being sick needs CONFIDENCE

Phase III – finding acceptance needs SHARING

Phase IV - finding meaning needs PARTNERSHIP

Phase I - crisis needs HOPE

Phase II - being sick needs CONFIDENCE

Phase III – finding acceptance needs SHARING

Phase IV - finding meaning needs PARTNERSHIP

Do you want compassionate care or the best outcomes?Do you want compassionate care or the best outcomes?

Gawanda - Is this, “Focus, aggressiveness, and inventiveness is what makes him extraordinary”, compassionate care?

Berwick - Will the Chasm’ s first four rules of “healing relationships; patient needs and values; the patient as the source of control; access to medical information” promote compassionate care?

Gawanda - Is this, “Focus, aggressiveness, and inventiveness is what makes him extraordinary”, compassionate care?

Berwick - Will the Chasm’ s first four rules of “healing relationships; patient needs and values; the patient as the source of control; access to medical information” promote compassionate care?

Compassion is a shared experience

Compassion is a shared experience

It is good for you

It is good for your family

It is good for your doctor

It is good for you

It is good for your family

It is good for your doctor